Background: In Sweden, the prevalence of tobacco use in the youth population differs by product and gender, but there are no longitudinal studies of gender differences in the uptake of smoking and use of oral snuff (OS).
Methods: A prospective cohort study ongoing in the County of Stockholm, encompassing 3,019 children recruited in 1997 in the fifth grade of compulsory school, of whom 96% were followed-up in the sixth grade.
Results: At baseline, 22% of the boys and 15% of the girls had ever smoked, respectively 8% and 3% had ever used oral moist snuff. One year later, the overall smoking prevalence had markedly increased, as did the transition to more advanced stages of smoking, especially among girls. Among boys who at baseline had only used oral snuff, 41% had also smoked cigarettes at follow-up. Lack of a firm intention to abstain from tobacco use was strongly associated with onset of experimentation within one year, particularly among boys.
Conclusions: Tobacco uptake in pre-adolescence differs between genders, with an earlier initiation among boys and a more rapid transition to regular smoking among girls. In most cases, experimentation with oral snuff among boys marks the transition to cigarette smoking.